In Anambra State in southeastern Nigeria, an effort is underway to use awareness and education to prevent a common parasitic disease. Many infected people have not sought help even though treatment is cheap and readily available. That’s because the disease carries a stigma.

The disease goes by several names: One is the medical term Schistosomiasis. Another is Bilharzia after the German pathologist who discovered it, Theodore Bilharz. But in Nigeria, many call it Amili Obara, which means blood in the urine. That’s a good indication a person has been infected with the flatworms, or flukes, that cause the disease.

One of those leading the awareness effort in Anambra State is Dr. Cliff Okafor, executive director of COHEDA, Community Health, Education and Development in Africa.

He says Schistosomiasis began to spread in Anambra State in the early 1960’s after a World Bank project dammed a stream to create rice farms. The project included various waterways for irrigation and artificial lakes for fishing. These were perfect breeding grounds for the flatworms. All that was needed was someone already infected to transmit the parasites into the environment.

Dr. Okafor says, "Unfortunately, somebody or some people introduced this flatworm by passing blood urine into the streams and the waterways. So the entire place became infected."

When an infected person urinates into a stream or lake, parasite eggs are deposited. After they hatch, they seek out a place to grow and multiply. And the perfect incubator is the snail, which is common in the waterways. After growing and multiplying, the flatworms leave the snail and re-enter the lake or stream.

Dr. Okafor says that’s when an unsuspecting person wading in the water can be infected.

"When people go to the stream, they penetrate the skin…the larvae penetrate the skin, and travel through the blood and settle in the bladder, causing the passage of blood in the urine – and causing a lot of chronic illness of the bladder, sometimes cancer, pain, infection in the bladder and other areas," he says.

The parasites are able to burrow through the skin, they do not need a cut or an open sore to enter the body. After a few days, the infected person may develop a rash or itchy skin. The symptoms can also include fever, chills, cough and muscle aches, which can develop within one to two months after infection.

The US Centers for Disease Control, the CDC, says repeated infections can cause damage to the bladder, liver, intestines and lungs. In rare cases, infections of the brain or spinal cord can trigger seizures or paralysis.

Despite the problems, Dr. Okafor says many people avoid treatment because of stigma.

"Ah, because they pass blood in urine and blood in urine is associated with sexually transmitted infections. And it’s a private place, because they call it private area. So, anything that happens to that private area seems be ‘under the pants’ and people don’t like to expose them," he says.

Treatment for the disease – whether it’s called Schistosomiasis, Bilharzia or Amili Obara – is the same. A person is given pills to take for a few days.

In the past in some places, efforts to prevent the disease by treating the snails in the waterways met with only partial success. Dr. Okafor says the best method is to prevent infected people from urinating in lakes and streams.

He says his NGO, COHEDA, educates schoolteachers and opinion makers about the disease. They in turn spread the word in their communities about prevention and treatment.

Of course, Nigeria is not alone in facing Schistosomiasis. The CDC estimates 200 million people worldwide are infected, with the greatest prevalence in sub-Saharan Africa, southern China, the Philippines and Brazil. No vaccine is available and there’s no effective drug to prevent infection.